Hematological toxicity of cyclin-dependent kinase 4/6 inhibitors in patients with breast cancer: a network meta-analysis and pharmacovigilance study.

ABSTRACT

OBJECTIVES: We aimed to evaluate and compare the risk of hematological adverse events (AEs) associated with CDK4/6 inhibitors using data from randomized controlled trials (RCTs) and Food and Drug Adverse Event Reporting System (FAERS) database. METHODS: The PubMed, Embase, and Cochrane Library databases were searched for RCTs related to abemaciclib, palbociclib, and ribociclib. A network meta-analysis (NMA) was conducted to compare the risks of hematological AEs, and a disproportionality analysis was performed to detect signals of hematological AEs. RESULTS: 16 RCTs comprising 16,350 breast cancer patients were included. Palbociclib and ribociclib had similar risks for hematological AEs, except a higher risk of grade 3-4 leukopenia observed with palbociclib (risk ratio [RR] 7.84, 95% confidence interval [95%CI] 1.33-41.28). Abemaciclib had a higher risk of anemia than both ribociclib (grade 1-4 RR 2.23, 95% CI 1.25 - 3.96; grade 3-4 RR 3.52, 95% CI 1.59 - 8.11) and palbociclib (grade 1-4 RR 1.65, 95%CI 1.03 - 2.59), but a lower risk of grade 3-4 of both leukopenia (RR 0.12, 95%CI 0.02 - 0.49) and neutropenia (RR 0.15, 95%CI 0.04 - 0.52) compared with palbociclib. Signals indicating occurrence of leukopenia, neutropenia, anemia, and thrombocytopenia were identified for three CDK4/6 inhibitors. CONCLUSION: Abemaciclib, palbociclib, and ribociclib showed significant but inconsistent hematological toxicity risks.